Neoadjuvant Therapy Followed By Surgery And Surgery Alone In The Treatment Of Locally Advanced Esophageal Cancer

Objective To investigate the feasibility and safety of preoperative neoadjuvant therapy(including neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy)followed by surgery in the treatment of locally advanced esophageal carcinoma.Methods From December 2012 to June 2014,12 patients with locally advanced esophageal squamous carcinoma(clinical stage IIIA-IIIC)were admitted in Jiangsu province people's hospital,4 patients underwent preoperative chemoradiotherapy combined with surgical treatment and 8 patients underwent preoperative chemotherapy combined with surgical treatment.Two courses of docetaxel plus cis-platinum were applied as neoadjuvant chemotherapy.During the same period,conventional fractionated radiotherpy with the radiation dose of40Gy/2.0Gy/20 F combined with the two courses of docetaxel plus cis-platinum were applied as neoadjuvant chemoradiotherapy.Radical surgery for esophageal carcinoma was operated after two to four weeks of neoadjuvant therapy.Of 12 patients,1 patient was in the stage T4 b and combined with esophageal perforation during the introperative exploration and the surgery was terminated after endoscopic stent implantation.11 patients(group A)successfully complicated the neoadjuvant therapy and surgery.Choose 20 matched patients with ESCC(group B)accepted surgery alone in the same time from esophageal cancer database to compare clinical indicators with group A.Results The operative time,intraoperative blood loss and the number ofmetastatic lymph nodes was less in group A than those in group B[(233.6±19.9)min vs.(257.3±28.9)min,(160.9±36.4)ml vs.(216.5±56.4)ml,(1.27±0.90)vs.(2.30±1.45)](P<0.05).The number of removal lymph nodes,postoperative chest fluid drainage and the postoperative hospital stay showed no significant in group A and group B[(16.9±5.5)vs(18.8±4.8),(1154.5±283.7)ml vs(1127.3±307.4)ml,(11.6±2.1)d vs(12.2±1.7)d](p>0.05).The postoperative complication rate was 27.3% in group A,including recurrent laryngael nerve injury(n=1),pulmonary infection(n=1)and atrial fibrillation(n=1).The postoperative complication rate was 25.0% in group B,including laryngael nerve injury(n=1),pulmonary infection(n=2),atrial fibrillation(n=1)and frequent ventricular premature beat(n=1).The complication rate showed no significant difference in group A and B.All patients recovered well after symptomatic treatment.No severe complications of Anastomotic fistula,heart failure,respiratory failure and so on occured,and no death case occured in 30 days after surgery.Follow up ranged from 9 to 26 months,1 patient of the group A and 4 patients of the group B came up with tumor recurrence.Conclusion The neoadjuvant therapy followed by surgery in the treatment of advanced esophageal carcinoma was feasible,safe and short-term outcomes are favorable.